1. Patient Safety and Quality in the NHS

Question 1

What were the consequences of no research evidence about quality and safety in the NHS 10/15 years ago?

Answer 1

A series of scandals as quality and safety of health services were poorly monitored and managed.

Question 2

What is clinical governance?

Answer 2

Framework through which NHS organisations are accountable for improving quality and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish.

Question 3

What has the NHS had a legal duty for since April 1999?

Answer 3

To put in place systems for monitoring and ensuring quality of care provided.

Question 4

What does the Health and Social Care act of 2012 say about the Secretary of State?

Answer 4

They must exercise functions in relation tot he health service to secure continuous improvement in quality of services including: effectiveness; safety; and quality of experiences, in relation to quality standards from NICE.

Question 5

What does evidence suggest about quality of care across the country?

Answer 5

There are variations in health care so not everyone is getting the best care.

Question 6

What can variation in health services suggest?

Answer 6

It may be appropriate or it suggests waste or inequity within the NHS from inefficient care.

Question 7

What is equity?

Answer 7

Everyone with the same need gets the same care.

Question 8

What is inequitable care?

Answer 8

Patients across England vary in the extent to which they receive high quality care and in access to care.

Question 9

What is an adverse event?

Answer 9

An injury caused by medical management (rather than the underlying disease) and that prolongs the hospitalisation, produces a disability, or both.

Question 10

What is a preventable adverse event?

Answer 10

An adverse even that could be prevented given the current state of medical knowledge.

Question 11

What are some of the reasons for medical errors?

Answer 11

Everyone is fallible, most medicine is complex and uncertain, most errors result from the system of inadequate training/long hours etc, personal efforts are necessary but not sufficient for safe care.

Question 12

What are the types of error?

Answer 12

Slips and lapses, mistakes, violation.

Question 13

Explain what is meant by slips and lapses type errors.

Answer 13

Error of action, the person knows what they want to do but the action does not turn out as intended.

Question 14

Explain what is meant by mistake type errors.

Answer 14

Error of knowledge or planning, the action goes as planned but fails to achieve intended outcome as the wrong action was taken.

Question 15

Explain what is meant by violation type errors.

Answer 15

Intentional deviations from protocols, standards, safe operating procedures, or other rules.

Question 16

Explain what is illustrated in the Swiss Cheese Model of Accident Causation.

Answer 16

There are successive layers of defences, barriers, and safeguards (layers of cheese). But hazards are able to penetrate all the barriers, which leads to losses (holes in the cheese).

Question 17

What are active failures?

Answer 17

Happen at the sharp end of practice, closest to the patient.

Question 18

What are latent conditions/failures?

Answer 18

Predisposing conditions that make active failures more likely to occur.

Question 19

What is the NHS Outcomes Framework?

Answer 19

Specific national outcome goals and indicators in 5 domains, linked to payments and financial incentives.

Question 20

What are the 5 domains of the NHS Outcomes Framework?

Answer 20

Preventing people from dying prematurely.
Enhancing quality of life for those with LTC.
Helping people recover from ill health/injury.
Ensuring people have a positive experience of care.
Treat and care for people in a safe environment.

Question 21

Who is held accountable for the NHS Outcomes Framework?

Answer 21

Health Secretary and NHS CB.

Question 22

What are the NICE Quality Standards?

Answer 22

Set of statements that are markers of high quality, clinical and cost effective patient care across a pathway or clinical area.

Question 23

How are the NICE Quality Standards decided?

Answer 23

Derived from evidence like NICE guidance or other NHS Evidence accredited sources. Produced with NHS and social care, along with their partners and service users.

Question 24

What is the role of Clinical Commission Groups (CCGs)?

Answer 24

Commission services for their local populations and drive quality through contracts.

Question 25

What is the role of Commissioning Outcomes Framework (COF)?

Answer 25

Hold CCGs accountable for progress in delivering outcomes using indicators and drive local improvement in quality and outcomes for patients.

Question 26

What are the COF indicators?

Answer 26

Measure quality and used to hold CCGs to account.

Question 27

What are is the Quality and Outcomes Framework (QOF)?

Answer 27

Sets national quality standards with indicators in primary care. Gives general practices points according to how well they perform against indicators. These points calculate practice payments and results are posted online.

Question 28

What are Quality Accounts?

Answer 28

Way to increase disclosure of information about performance at organisational and individual levels, all trusts have to publish them.

Question 29

What are the features of Quality Accounts?

Answer 29

All trusts need to publish them. Published annually. Publicly available. Focus on safety, effectiveness, and patient experience.

Question 30

What is the role of Care Quality Commission (CQC)?

Answer 30

Consider NICE quality standards and check quality accounts.

Question 31

What are the actions CQC can take?

Answer 31

They can impose registration ‘conditions’ if not satisfied, make unannounced visits, issue warning notices, fines, prosecution, restrictions on activities, and closure.

Question 32

What is a clinical audit?

Answer 32

Quality improvement process seeking to improve patient care and outcomes through systematic review of care against criteria and the implementation of change.

Question 33

What are the components of a clinical audit?

Answer 33

Setting standards, measuring current practice, comparing results with standards, changing practice, re-auditing to make sure practice improves.

Question 34

How can a systems-based approach promote quality in health care?

Answer 34

Remove human factors to improve safety of design: avoid reliance on memory, makes things visible, standardises common practices, etc.